Include severity of symptom to patient and distress that symptom causes caregiver1. Delusions: Does the patient believe that others are stealing from him/her or planning to harm him/her in some way__.2. Hallucinations: Does the patient hearing voices or does he/she talk to people who are not there__.3. Agitation/Aggression: Is the patient stubborn or resistive of help from others__.4. Depression/Dysphoria: Does the patient act as if he/she were sad or in low spirits__.5. Anxiety: Does the patient become upset when separated from you__. Does he/she have any other signs of nervousness such as shortness of breath, sighing, being unable to relax, or feeling excessively tense__.6. Elation/Euphoria: Does the patient appear to feel too good or act excessively happy__.7. Apathy/Indifference: Does the patient seem less interested in his/her usual activities and in the activities and plans of others__.48. Disinhibition: Does the patient seem to act impulsively, for example, talking to strangers as if he/she knows them, or saying things that may hurt people's feelings__.9. Irritability/Lability: Is the patient impatient and cranky__. Does he/she have difficulty coping with delays or waiting for planned activities__.10. Motor Disturbance: Does the patient engage in repetitive activities such as pacing around the house, handling buttons, wrapping string, or doing other activities repeatedly__.11. Nighttime behaviors: Does the patient awaken you during the night, rise too early in the morning, or take excessive naps__.12. Appetite: Has the patient lost or gained weight, or had a change in the type of food he/she likes__.

Include severity of symptom to patient and distress that symptom causes caregiver1. Delusions: Does the patient believe that others are stealing from him/her or planning to harm him/her in some way__.2. Hallucinations: Does the patient hearing voices or does he/she talk to people who are not there__.3. Agitation/Aggression: Is the patient stubborn or resistive of help from others__.4. Depression/Dysphoria: Does the patient act as if he/she were sad or in low spirits__.5. Anxiety: Does the patient become upset when separated from you__. Does he/she have any other signs of nervousness such as shortness of breath, sighing, being unable to relax, or feeling excessively tense__.6. Elation/Euphoria: Does the patient appear to feel too good or act excessively happy__.7. Apathy/Indifference: Does the patient seem less interested in his/her usual activities and in the activities and plans of others__.48. Disinhibition: Does the patient seem to act impulsively, for example, talking to strangers as if he/she knows them, or saying things that may hurt people's feelings__.9. Irritability/Lability: Is the patient impatient and cranky__. Does he/she have difficulty coping with delays or waiting for planned activities__.10. Motor Disturbance: Does the patient engage in repetitive activities such as pacing around the house, handling buttons, wrapping string, or doing other activities repeatedly__.11. Nighttime behaviors: Does the patient awaken you during the night, rise too early in the morning, or take excessive naps__.12. Appetite: Has the patient lost or gained weight, or had a change in the type of food he/she likes__.

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